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Wrist Arthritis Clinical Presentation

  • Author: Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth); Chief Editor: Harris Gellman, MD  more...
 
Updated: Nov 25, 2015
 

History

Patients presenting with osteoarthritis (OA) of the wrist are typically older than 50 years. However, RA and its variants may manifest earlier. Likewise, in patients with previous trauma, secondary OA can appear at a young age.

The predominant symptom of wrist arthritis is pain. In the early stages of wrist arthritis, pain is usually aggravated during the extremes of movement. As the disease progresses, the pain gradually worsens to involve the full, available range of motion.

The range of motion may also gradually deteriorate. OA may progress to such an extent that, in severe cases, the wrist has no movement. However, in rare cases in which the patient has inherent hyperelasticity, as in those with Ehlers-Danlos Syndrome or Marfan Syndrome, the wrist may maintain have good range of motion despite severe degenerative changes. The images below depict a patient with normal range of motion.

Range of motion may be normal in hyperelastic indi Range of motion may be normal in hyperelastic individuals despite underlying wrist arthritis.
Range of motion may be normal in hyperelastic indi Range of motion may be normal in hyperelastic individuals despite underlying wrist arthritis.

Deformity is another feature of wrist arthritis. This is common in RA, in which deformity may be complicated by association with subluxation of the radiocarpal and inferior radioulnar joints. Swelling of the wrist is one of the most common manifestations of RA and may occur because of synovial thickening.

Because the wrist stabilizes the hand for functioning, pain and deformity may result in the loss of such function with weakness of the hand grip. Wrist deformity and instability reduce support for the hand to grasp, impairing dexterity, whereas stiffness and the inability to extend the wrist deprive the fingers of the tenodesis effect.

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Physical Examination

Attrition rupture of the tendons may occur, specifically when they glide over the rough osteophytes, resulting in loss of function in the fingers. The flexor pollicis longus tendon is prone to such ruptures over the distal pole of the scaphoid; this is called a Mannerfelt lesion.

Cases have been described in the literature in which the flexor pollicis longus, flexor digitorum superficialis, and flexor digitorum profundus tendons to the index finger all are ruptured, with osteophytes at the distal pole of the scaphoid. Likewise, the small and ring finger extensor digitorum communis tendons are prone to attrition ruptures.

Persistent synovitis at the distal radioulnar joint may result in dorsal subluxation of the distal ulna, crepitus during forearm pronation and supination, deformity of the carpus, and rupture of the extensor digitorum communis tendons; this is called caput ulna syndrome. Because the tendons in the flexor and extensor compartments of the wrist have a synovial lining, synovitis of the wrist usually results in tenosynovitis, and may lead to tendon subluxation, adhesion, and, finally, rupture. See image below.

Synovitis of the wrist with extensor tenosynovitis Synovitis of the wrist with extensor tenosynovitis.

Classic rheumatoid wrist arthritis begins with radial deviation of the wrist, resulting in ulnar head prominence. This progresses to supination and ulnar translation of the carpus, finally leading to volar subluxation of the radiocarpal joint. Crepitus in the wrist becomes more apparent as joint disease progresses.

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Contributor Information and Disclosures
Author

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth) Consultant Spinal Surgeon, Department of Trauma and Orthopaedics, Sunderland Royal Hospital, UK

Palaniappan Lakshmanan, MBBS, MS, AFRCS, FRCS(Tr&Orth) is a member of the following medical societies: British Orthopaedic Association, AOSpine

Disclosure: Nothing to disclose.

Coauthor(s)

Lester Sher, MB, BCh, FRCS Honorary Clinical Lecturer, Department of Orthopedics, Wansbeck Hospital, UK

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert J Nowinski, DO Clinical Assistant Professor of Orthopaedic Surgery, Ohio State University College of Medicine and Public Health, Ohio University College of Osteopathic Medicine; Private Practice, Orthopedic and Neurological Consultants, Inc, Columbus, Ohio

Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

References
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Severe wrist arthritis.
The clinical presentation of wrist arthritis can be severe deformity, especially in patients with rheumatoid arthritis.
Rheumatoid arthritis of the wrist.
Osteoarthritis of the wrist.
Osteoarthritis of the wrist, lateral view.
Range of motion may be normal in hyperelastic individuals despite underlying wrist arthritis.
Range of motion may be normal in hyperelastic individuals despite underlying wrist arthritis.
Synovitis of the wrist with extensor tenosynovitis.
Universal incision of the wrist.
Extensor retinaculum of the wrist.
Exposure of the distal end of the ulna for a Darrach procedure.
After resection of the distal ulna.
Radiolunate fusion with staples.
Follow-up of radiolunate fusion (limited arthrodesis) shows good dorsiflexion and palmar flexion.
Intramedullary pin fixation for wrist arthrodesis.
Total wrist fusion using an AO (Arbeitsgemeinschaft für Osteosynthesefragen, or Association for the Study of Osteosynthesis) plate in osteoarthritis of the wrist.
Total wrist fusion using an AO (Arbeitsgemeinschaft für Osteosynthesefragen, or Association for the Study of Osteosynthesis) plate in a person with rheumatoid arthritis of the wrist.
Wrist arthroplasty in rheumatoid arthritis of the wrist.
Distal radioulnar joint fusion with distal ulnar resection (Sauve-Kapandji procedure).
 
 
 
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